CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(03): 135-139
DOI: 10.1055/s-0042-1742771
Original Article

Typical and Atypical Imaging Findings of Hepatocellular Carcinoma on Multiphasic MDCT Scan in Histologically Proved Cases

Umakant Prasad
1   Department of Radiodiagnosis, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
Deepak Kumar
1   Department of Radiodiagnosis, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
Rashmi Rani Bharti
2   Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar
Sanjay Kumar Suman
1   Department of Radiodiagnosis, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
Aishwerya Singh
1   Department of Radiodiagnosis, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
Ravikant Kumar
3   Department of Gastroentrology, Indira Gandhi Institute of Medical Science, Patna, India
› Author Affiliations
Funding None.


Objective The purpose of this study was to find out the incidence of typical and atypical radiological imaging findings of hepatocellular carcinoma (HCC) on multiphase multidetector computed tomography (MDCT) scans in histologically proven cases.

Materials and Methods A multiphase computed tomography study of 73 patients with histologically proven HCC was evaluated by a radiologist. Our multiphasic protocol was composed of precontrast, arterial, portal, and delayed venous phases. The reviewers analyzed the CT images for tumor size, enhancement patterns of HCC in different phases, relative timing of washout, internal cystic changes, and presence of dysmorphic intratumoral vessel aneurysms or arteriovenous shunt.

Results Most of the cases (95.9%) showed typical enhancement patterns in MDCT, i.e., enhancements in the arterial phase with the portal or delayed venous phase contrast washout. Three cases (4.9%) out of 73 HCC showed enhancements in the portal phase and washout in the delayed venous phase. Seven cases out of total 73 HCC (9.5%) patients showed heterogeneous enhancements in both arterial and portal phases and contrast washout in the delayed venous phase. Venous thrombosis was noted in about 44 cases (60%) out of total 73 patients, in which portal vein thrombosis was more common than hepatic veins/inferior vena cava.

Conclusion Most of the HCC show typical enhancement patterns, i.e., heterogeneous enhancements in the arterial phase and washout in the portal venous phase when we use MDCT. These findings are higher than those described previously. However, in our study, the main difference with MDCT was lower frequency of intratumoral pseudoaneurysm and bile duct invasion, and intratumoral fat and calcification (atypical character of HCC) were not found which were rare findings in previous study.

Publication History

Article published online:
18 February 2022

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  • Reference

  • 1 Bruix J, Sherman M, Llovet JM. et al; EASL Panel of Experts on HCC, European Association for the Study of the Liver. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. J Hepatol 2001; 35 (03) 421-430
  • 2 Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379 (9822): 1245-1255
  • 3 Dimitroulis D, Damaskos C, Valsami S. et al. From diagnosis to treatment of hepatocellular carcinoma: an epidemic problem for both developed and developing world. World J Gastroenterol 2017; 23 (29) 5282-5294
  • 4 Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94 (02) 153-156
  • 5 Velázquez RF, Rodríguez M, Navascués CA. et al. Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology 2003; 37 (03) 520-527
  • 6 Omata M, Lesmana LA, Tateishi R. et al. Asian Pacific Association for the study of the liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010; 4 (02) 439-474
  • 7 Bruix J, Sherman M. Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology 2005; 42 (05) 1208-1236
  • 8 Forner A, Vilana R, Ayuso C. et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47 (01) 97-104
  • 9 Nagano K, Fukuda Y, Nakano I. et al. An autopsy case of multilocular cystic hepatocellular carcinoma without liver cirrhosis. Hepatogastroenterology 2000; 47 (35) 1419-1421
  • 10 Gonwa ME, Casillas J, Livingstone AS, Robinson PG. Cystic hepatocellular carcinoma: CT findings. J Comput Assist Tomogr 1991; 15 (06) 1045-1047
  • 11 Pombo F, Rodriguez E, Arnal-Monreal F. Multicystic fibrolamellar hepatocellular carcinoma. CT appearance. Clin Imaging 1993; 17 (01) 67-69
  • 12 Sotiropoulos GC, Malago M, Molmenti EP. et al. Disease course after liver transplantation for hepatocellular carcinoma in patients with complete tumor necrosis in liver explants after performance of bridging treatments. Eur J Med Res 2005; 10 (12) 539-542
  • 13 Majno PE, Adam R, Bismuth H. et al. Influence of preoperative transarterial lipiodol chemoembolization on resection and transplantation for hepatocellular carcinoma in patients with cirrhosis. Ann Surg 1997; 226 (06) 688-701
  • 14 Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer 1954; 7 (03) 462-503
  • 15 Okuda K. Hepatocellular carcinoma: clinicopathological aspects. J Gastroenterol Hepatol 1997; 12 (9-10): S314-S318
  • 16 Theise ND, Curado MP, Franceschi S. et al. Hepatocellular carcinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND. eds. WHO Classification of Tumours of the Digestive System. 4th ed.. Lyon, France: IARC; 2010: 205-216
  • 17 Kojiro M. Histopathology of liver cancers. Best Pract Res Clin Gastroenterol 2005; 19 (01) 39-62
  • 18 Haider Z, Idris M, Sajjad Z, Humayun S, Kashif N, Ali S. Intratumoral pseudoaneurysms in hepatocellular carcinoma: do they occur de novo without any prior intervention? A tertiary care center experience of 6 years. Acta Radiol 2015; 56 (09) 1027-1033